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. 2022 Nov 5;4(6):dlac113.
doi: 10.1093/jacamr/dlac113. eCollection 2022 Dec.

Occurrence and significance of fluoroquinolone-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora in Ghanaian patients undergoing prostate biopsy

Appiah-Korang Labi  1 , Noah Obeng-Nkrumah  2 , Nicholas T K D Dayie  3 , Ben Molai Addo  4 , Mary-Magdalene Osei  3 , Ama Fenny  5 , Beverly Egyir  6 , James Edward Mensah  7
Affiliations

Occurrence and significance of fluoroquinolone-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora in Ghanaian patients undergoing prostate biopsy

Appiah-Korang Labi et al. JAC Antimicrob Resist. .

Abstract

Background: Reports suggest that fluoroquinolone (FQ)-resistant and ESBL-producing rectal flora are associated with infectious complications in men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-B).

Objectives: We investigated the relationship between carriage of FQ-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora, and the 30 day incidence rate of post-TRUS-B infectious complications.

Methods: From 1 January 2018 to 30 April 2019, rectal swabs of 361 patients were cultured pre-TRUS-B for FQ-resistant and ESBL-producing flora. Patients were followed up for 30 days for infectious complications post-biopsy. Multivariable logistic regression analyses were used to identify risk factors.

Results: Overall, 86.4% (n = 312/361) and 62.6% (n = 226/361) of patients carried FQ-resistant and ESBL-producing E. coli and K. pneumoniae complex, respectively. Approximately 60% (n = 289/483) of the FQ-resistant and 66.0% (n = 202/306) of the ESBL-positive isolates exhibited in vitro resistance to the pre-biopsy prophylactic antibiotic regimen of levofloxacin and gentamicin. Amikacin and meropenem were the most effective antibiotics against the MDR rectal E. coli and K. pneumoniae complex (78.7% and 84.3%, respectively). The 30 day incidence rate for post-biopsy infections was 3.1% (n = 11/361), with an overall high probability (96.9%) of staying free of infections within the 30 day period post-TRUS-B. Antibiotic use in the previous 3 months was a risk factor for rectal carriage of FQ-resistant and ESBL-positive isolates. Rectal colonization by ESBL-positive E. coli and K. pneumoniae complex comprised an independent risk factor for post-biopsy infectious complications.

Conclusions: The findings suggest that a change in prophylactic antibiotics to a more targeted regimen may be warranted in our institution.

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Figures

Figure 1.
Figure 1.
Prevalence of rectal carriage, post-TRUS-B infections, and antibiotic susceptibility profile of FQ-resistant and ESBL-producing isolates. *Ampicillin not reported for K. pneumoniae complex due to intrinsic resistance; tigecycline tested for only E. coli.
Figure 2.
Figure 2.
Antibiotic co-resistance heatmap of all FQ-resistant and ESBL-producing rectal flora. Colour gradient (from light to dark) indicates increasing co-resistance. Figures within cells denote the percentage co-resistance between two overlapping antibiotics. Meropenem and amikacin exhibited the least co-resistance patterns and showed the widest coverage over MDR rectal flora. FOX, cefoxitin; CTX, cefotaxime; GEN, gentamicin; AMK, amikacin; TZP, piperacillin/tazobactam; TET, tetracycline; TGC, tigecycline; STX, co-trimoxazole, MEM, meropenem; AMP, ampicillin; AMC, amoxicillin/clavulanic acid; CXM, cefuroxime.
Figure 3.
Figure 3.
Occurrence and clinical characteristics of infection post-TRUS-B.
Figure 4.
Figure 4.
Distribution of (a) TRUS-B cases and infections by week; and (b) Kaplan–Meier curve for the cumulative probability of infections within 30 days post-TRUS-B. The probability of getting post-TRUS-B infection reduces from 100% to 96.9% from Day 0 to Day 28. The probability of staying free of infection is high at 96.9%.
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